How to File a Reimbursement Claim Under Health Insurance?

When Can You File a Health Insurance Reimbursement Claim?

You can file a reimbursement claim under your health insurance policy under the following circumstances:

If you want to obtain medical treatment at a non-network hospital of your insurance company
If you were admitted to a non-network hospital of your insurance company during a medical emergency
If your cashless claim request was rejected by the insurance company

Steps to File a Reimbursement Claim Under Health Insurance

Follow the steps given below to file a reimbursement claim under your health insurance policy:

Step 1: Intimate the Insurance Company

The first thing is to inform your insurance company or TPA about your emergency or planned hospitalization. In case you plan to get hospitalized for treatment, you must inform your insurer or TPA at least 48 hours before admission. On the other hand, if you have been admitted to a hospital due to a medical emergency, intimate your insurer or TPA within 24 hours.

Step 2: Obtain Treatment

Once you have informed your insurer, simply obtain treatment at the hospital and focus completely on getting cured.

Step 3: Pay the Hospital Bill

At the time of getting discharged from the hospital, make sure to pay the entire hospital bill in full.

Step 4: Collect All Your Documents

Make sure to obtain all the medical documents related to your treatment at the time of getting discharged from the hospital, including the hospital bills and discharge summary.

Step 5: Fill Up the Claim Form

Once you have been discharged from the hospital, fill up the health insurance claim form of your insurance company. The form can be easily found on the website of the insurance company.

Step 6: Submit All the Documents to the Insurance Company

You should submit all the required documents to your insurance company within the stipulated time frame (usually 15-30 days). You can check your policy documents or contact your insurer to know the exact list of documents required.

Step 7: Document Verification and Evaluation of the Claim Request

The insurance company will verify all the documents received and cross-check with the coverage available under your health insurance policy. Once the documents have been verified, your claim will be either accepted or rejected within 30 days of receiving the documents. If the insurer requires more documents, they will let you know.

Step 8: Payment of Claim Amount

If your claim has been accepted, the insurance company will pay you the claim amount.

Documents Required to File a Reimbursement Claim Under Health Insurance

Here is a list of documents that you may need to submit while filing a reimbursement claim under your health insurance policy:

Duly filled health insurance claim form
Copy of health card/ insurance policy
Original investigation reports like blood test reports, X-rays, CT scans, etc.
Copy of doctor consultation papers or prescriptions
Original hospital discharge summary/ day care summary
Original hospital bills
Original medicine bills
Original bill payment receipts
Original implant sticker/invoice
FIR or medico-legal certificate (MLC) (in case of an accident)
Copy of KYC documents
NEFT details

Things to Keep in Mind While Filing a Health Insurance Reimbursement Claim

Check out a few things that you should keep in mind while filing a health insurance reimbursement claim:

Read your policy documents carefully and know what is covered and not covered under your policy.
Go through the claim process of your insurance company while buying the policy so that you do not face any hassles at the time of filing the claim.
Make sure to keep a copy of all the documents that you submit to your insurer as you will have to submit the original copy.
Check the waiting periods applicable under your policy and file a claim after the waiting period is over.
Remember to renew your health policy on time as you cannot raise a claim if your policy has expired.

Summing It Up

Filing a claim is the first step to obtaining financial assistance from your insurance company at the time of a medical emergency. If you cannot file a cashless claim, a reimbursement claim is the best option for you. Make sure to carefully go through the steps involved in filing a reimbursement claim so that you make no mistakes. Also, keep the above-mentioned things in mind while filing a reimbursement claim under your health insurance policy.

Health insurance companies

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Disclaimer: The list mentioned is according to the alphabetical order of the insurance companies. Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by any insurer. For complete list of insurers in India refer to the Insurance Regulatory and Development Authority of India website www.irdai.gov.in

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*We will respond in the first instance within 30 minutes of the customers contacting us. 30-minute claim support service is for the purpose of giving reasonable assistance to the policyholder in pursuance of the claim. Settlement of claim (including cashless claim) is the responsibility of the insurer as per policy terms and conditions. The 30- minute claim support is subject to our operations not being impacted by a system failure or force majeure event or for reasons beyond our control. For further details, 24x7 Claims Support Helpline can be reached out at 1800-258-5881.

*Product information is authentic and solely based on the information received from the Insurer. Policybazaar is acting only as a facilitator and claims settlement shall be at the sole discretion of the Insurer. Policybazaar does not provide any medical or surgical advice or diagnosis and is not responsible for your interactions / treatment by a medical practitioner/hospital. Please consult a registered medical practitioner for any medical or surgical advice. The Information that you obtain or receive from Policybazaar, and its employees, or otherwise on the Website is for informational purposes only. As per the Insurance guidelines, you are allowed to cancel the policy with-in 30 days from the date of Issuance of policy.This option is available incase of policies with a term of one year or more.

*All the health insurance plans cover hospitalization expenses including COVID-19 treatment cover up to the specified limits. You can also buy specific COVID-19 health insurance policies such as Corona Kavach Policy and Corona Rakshak policy.

**All savings and online discounts are provided by insurers as per IRDAI approved insurance plans. #Tax Benefits are subject to changes in tax laws. GST Exemptions depend on fulfilment of qualification criteria and submission of relevant documents.

*₹1748/month is the starting price for a 1 crore health insurance for an 18-year-old male, with no pre-existing diseases. Discount on renewal premium is subject to the number of wellness points earned in the health insurance policy. For more details about the plans, please read the sale brochure carefully to get upto 100% discount on renewal premium.

*₹400/month is the starting price for ₹ 5 lakh Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases

*₹541/month is the starting price for ₹ 10 lakh Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases

*₹762/month is the starting price for ₹ 1 Crore Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases

*₹243/month(₹ 8/day) is the starting price for a 5 lakh health insurance for a 20-year-old male, non-smoker, living in Bengaluru with no pre-existing diseases

*₹2020/month is the starting price for ₹ 1 Cr Health insurance for a 50 year old male & 50 years old female, living in Bangalore with no pre-existing diseases rounded off to nearest 10.

*₹390/month (₹13 per day) is starting price for 1 cr. Health insurance for 25 years old male, with pre-existing diseases, residing from tier 1 city rounded off to the nearest 10.

*No medical tests are required unless requested by the insurer’s underwriter. In-case of pre-existing diseases relevant medical proof would be required as per the terms and condition of the policy opted.

*The values taken for effective cost calculation are indicative values and may change as per the selected plan.

*Coverage upto double the amount of Sum Insured is available on certain covers for a minimum plan of Rs. 5 Lakh on the first claim only to an individual of upto 45 years of age with no pre-existing diseases. The benefit is available with or without extra cost depending on the plan chosen.

*Coverage of pre-existing diseases is provided by insurer as per their underwriting policy.

*The scope of coverage may vary from plan to plan.

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Tax Benefits are subject to changes in tax laws. GST Exemption depends on fulfilment of qualification criteria and submission of relevant documents as required by the insurers. For more details on risk factors, terms and conditions, please read the sales brochure and applicable rules and regulation carefully before concluding a sale.

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